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“What I appreciate the most is the breadth of experience Dr. Chen shared in reference to each of the formula - some of the uses and combinations are new to me and will be helpful in my clinical practice.” L.C.

“I learned many new connections between TCM & Western medication which will help me to mesh both together. Excellent seminars.” M.B.

LONG DAN XIE GAN TANG
(GENTIANA DECOCTION TO DRAIN THE LIVER)
TRADITIONAL USE, PHARMACOLOGICAL EFFECTS AND CLINICAL RESEARCH

By John Chen, L.Ac., O.M.D., Pharm.D., Ph.D.

*Long Dan Xie Gan Tang* (Gentiana Decoction to Drain the Liver)
Diagnosis	Signs and Symptoms	Treatment	Herbs
Excess fire in the Liver and Gallbladder	Headache, bitter taste in the mouth, painful eyes and ears, or deafness: damp-heat traveling upward along the Liver channel Hypochondriac pain: damp-heat traveling along the Liver channel Swelling and itching of the external genitalia, sweating of the groin, dysuria and leukorrhea: damp-heat traveling downwards to the lower jiao	Sedates the excess fire in the Liver and Gallbladder Clears the damp-heat in the lower jiao	Long Dan Cao (Radix Gentianae) sedates excess fire in the Liver and Gallbladder and clears damp-heat in the lower jiao. Huang Qin (Radix Scutellariae) and Zhi Zi (Fructus Gardeniae) disperse fire and damp-heat in all three jiaos. Ze Xie (Rhizoma Alismatis), Chuan Mu Tong (Caulis Clematidis Armandii) and Che Qian Zi (Semen Plantaginis) dispel damp-heat through the urine. Sheng Di Huang (Radix Rehmanniae) and Dang Gui (Radicis Angelicae Sinensis) nourish and protect the yin and the blood from bitter and cold herbs. Chai Hu (Radix Bupleuri) regulates Liver qi and guides all of the herbs to the Liver. Gan Cao (Radix Glycyrrhizae) harmonizes the formula.

CHINESE THERAPEUTIC ACTIONS

Sedates excess fire in the Liver and Gallbladder
Clears damp-heat in the lower jiao

CLINICAL MANIFESTATIONS

Flaring of excess fire in the Liver and Gallbladder: headache, red eyes, hypochondriac pain, bitter taste in the mouth, deafness, and swollen or painful inner ears.

Damp-heat in the lower jiao: swelling and itching of the external genitalia, sweating in the groin, dysuria, turbid urine, and yellow foul-smelling leukorrhea in women.

CLINICAL APPLICATIONS

Hypertension, hepatitis, hepatic cirrhosis, acute icteric hepatitis, acute cholecystitis, gastritis, upper gastrointestinal bleeding, erythromatosis, urinary tract infection, urethritis, cystitis, nephritis, shingles, herpes zoster, chancre, gonorrhea, syphilis, leukemia, orchitis, prostatitis, male sexual dysfunction, bartholinitis, eczema of the scrotum, erysipelas, pelvic inflammatory disease, polycystic ovary syndrome, endometriosis, fallopian tube infection, oophoritis, prolapsed uterus, mastitis, cervicitis, abnormal vaginal discharge, Behcet's disease, acute conjunctivitis, acute otitis media, allergic rhinitis, oral lichen planus, hyperthyroidism, migraine, diabetes mellitus, and sciatica.

PHARMACOLOGICAL EFFECTS

Antibiotic: Decoction of Long Dan Xie Gan Tang was associated with a marked antibacterial effect, especially against beta-hemolytic streptococcus. (i)

Anti-inflammatory: Oral administration of Long Dan Xie Gan Tang in decoction was associated with a marked anti-inflammatory effect in mice, with maximum effect observed 4 to 6 hours after ingestion. The mechanism of action is attributed to an inhibitive effect on blood vessel permeability. (ii)

Immunostimulant: Oral administration of Long Dan Xie Gan Tang decoction at 50 g/kg was associated with increased phagocytic activity in mice within 3-6 hours. (iii)

Antiallergic: Oral administration of Long Dan Xie Gan Tang decoction at 10 g/kg for 2 days was effective in minimizing shock and death caused by severe allergic reaction. (iv)

Cardiovascular: Long Dan Xie Gan Tang was associated with a marked hypotensive effect in anesthetized cats. The mechanisms of action were attributed to its effect of lowering heart rate, decreasing force of heart contraction, and dilation of blood vessels. (v)

CLINICAL STUDIES AND RESEARCH

Hypertension: In one study, modified Long Dan Xie Gan Tang was used to treat patients with hypertension with 88.89% effectiveness. (vi) In another report, it was mentioned that Long Dan Xie Gan Tang is most effective for hypertension with headache, irritability, insomnia, thirst, bitter taste in the mouth, dysuria, and a wiry-rapid pulse. (vii) Lastly, one study of 100 hypertensive patients characterized by Liver fire rising reported good results when treated with a herbal formula that contained Long Dan Xie Gan Tang plus Xia Ku Cao (Spica Prunellae), Jue Ming Zi (Semen Cassiae), Gou Teng (Ramulus Uncariae cum Uncis), and others. (viii)

Hepatitis: It has been shown in many studies that Long Dan Xie Gan Tang has a marked effect in treating hepatitis. In one study, 32 patients with non-icteric hepatitis were treated with Long Dan Xie Gan Tang with complete recovery in 27 cases, some improvement in 4 cases, and no effect in one case. (ix) In another study, 30 patients with icteric hepatitis were treated with Long Dan Xie Gan Tang with good results. The study reported improvement in most cases within 3-9 days, with jaundice resolving after 21.5 days and liver enzymes returning to normal after 30.8 days. (x) Lastly, one study of 40 patients with icteric jaundice reported 87.5% effectiveness using modified Long Dan Xie Gan Tang in decoction for 14 days per course of treatment. (xii)

Cholecystitis: In one report, 8 patients with acute cholecystitis were treated with complete recovery in all cases using Long Dan Xie Gan Tang with the addition of Ku Lian Pi (Cortex Meliae) and Da Huang (Radix et Rhizoma Rhei). (xii) Another study reported similar success using Long Dan Xie Gan Tang with the addition of Yin Chen Hao (Herba Artemisiae Scopariae) and Da Huang (Radix et Rhizoma Rhei). (xiii) Lastly, 81 patients with acute cholecystitis were treated with 96.2% effectiveness using Long Dan Xie Gan Tang plus Yin Chen Hao (Herba Artemisiae Scopariae), Chuan Lian Zi (Fructus Toosendan), and Da Huang (Radix et Rhizoma Rhei). (xiv)

Gastritis: According to one study, 47 patients with gastritis (characterized by damp-heat in the Spleen and Stomach, or Liver and Stomach heat) were treated with Long Dan Xie Gan Tang with significant improvement in 14 cases, moderate improvement in 31 cases, and no effect in 2 cases. (xv)

Upper gastrointestinal bleeding: In one study, 200 patients with upper gastrointestinal bleeding were treated with modified Long Dan Xie Gan Tang with 98% effectiveness. The stool tested negative for the presence of blood within an average of 4 days. (xvi)

TOXICOLOGY

In acute toxicology studies, oral administration of the formula at 26 g/kg showed no adverse reactions other than a short-term decrease in spontaneous physical activities (activities without a stimulus). No mortality was reported. With intravenous injection, the LD50 was determined to be 72g/kg in mice. (xvii)

OTHER USES

Long Dan Xie Gan Tang is one of the most essential and commonly used formulas today. It treats various conditions caused by excess fire in the Liver and Gallbladder. Key symptoms include a red tongue body with a greasy yellow coating, short temper, bitter taste, painful urination, yellow, foul-smelling vaginal discharge, genital itching, headache, redness of the eyes, painful ears, etc.

According to Wei-Yen Chang, Long Dan Xie Gan Tang can be combined with other formulas for the following disorders:

Migraines and headaches caused by Liver yang rising: use with Tian Ma Gou Teng Yin (Gastrodia and Uncaria Decoction).

Headache in menopausal women due to flaring of Kidney fire: add Bai Hu Tang (White Tiger Decoction) and Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pills).

Various kinds of lower jiao infections, such as bladder infection, urinary tract infection, infection of the reproductive organs and chronic pelvic infection: add Ba Zheng San (Eight-Herb Powder for Rectification).

Nephritis and glomerulonephritis: add Ba Zheng San (Eight-Herb Powder for Rectification), Shui Ding Xiang (Herba Ludwigiae Prostratae) and Xian Feng Cao (Herba Bidentis). For chronic nephritis, add Ba Wei Di Huang Wan (Eight-Ingredient Pill with Rehmannia).

Glaucoma and increased pressure in the eyes: add Ma Bian Cao (Herba Verbenae), Qian Li Guang (Herba Senecionis Scandens), Hu Zhang (Rhizoma Polygoni Cuspidati), Hu Yao Huang (Herba Leucas Mollissimae), and Ba Zheng San (Eight-Herb Powder for Rectification).

REFERENCES
(i) Zhong Yao Yao Li Du Li Yu Lin Chuang (Pharmacology, Toxicology and Clinical Applications of Chinese Herbs); 1991, (1):5
(ii) Zhong Yi Fang Ji Xian Dai Yan Jiu (Modern Study of Medical Formulae in Traditional Chinese Medicine), 1997; 318-319
(iii) Zhong Yi Fang Ji Xian Dai Yan Jiu (Modern Study of Medical Formulae in Traditional Chinese Medicine), 1997; 318-319
(iv) Zhong Yao Yao Li Du Li Yu Lin Chuang (Pharmacology, Toxicology and Clinical Applications of Chinese Herbs); 1991, (1):5
(v) Zhong Yi Fang Ji Xian Dai Yan Jiu (Modern Study of Medical Formulae in Traditional Chinese Medicine), 1997; 320
(vi) Ke Yan Tong Xun (Journal of Science and Research); 1983, (2):1
(vii) Jiang Xi Zhong Yi Yao (Jiangxi Chinese Medicine and Herbology); 1959, (10):18
(viii) Nan Jing Zhong Yi Xue Yuan Xue Bao (Journal of Nanjing University of Traditional Chinese Medicine), 1986, 1:20
(ix) Xin Yi Yao Xue Za Zhi (New Journal of Medicine and Herbology); 1978, 10:49
(x) Ke Yan Tong Xun (Journal of Science and Research); 1983, (2):13
(xi) Jiang Xi Yi Xue Yuan Xue Bao (Medical Journal of Jiangxi University of Medicine), 1998, 3:123
(xii) Zhong Yi Fang Ji Xian Dai Yan Jiu (Modern Study of Medical Formulae in Traditional Chinese Medicine), 1997; 321
(xiii) Nei Meng Gu Zhong Yi Yao (Traditional Chinese Medicine and Medicinals of Inner Mongolia), 1987, 6(2):42
(xiv) Ji Lin Zhong Yi Yao (Jilin Chinese Medicine and Herbology), 1997, 2:32
(xv) Shang Hai Zhong Yi Za Zhi (Shanghai Journal of Chinese Medicine), 1996, 6:38
(xvi) Zhong Yi Fang Ji Xian Dai Yan Jiu (Modern Study of Medical Formulae in Traditional Chinese Medicine), 1997; 322
(xvii) Zhong Yi Fang Ji Xian Dai Yan Jiu (Modern Study of Medical Formulae in Traditional Chinese Medicine), 1997; 320

ABOUT THE AUTHOR

John K. Chen, L.Ac., Pharm.D., O.M.D., Ph.D.

Dr. John Chen is a recognized authority in both western pharmacology and Chinese Herbal Medicine. He teaches at the USC School of Pharmacy, Emperor’s College, Yo San University of TCM, OCOM, Five Branches, AOMA and ACTCM. Dr. Chen’s most recent published work is Chinese Medical Herbology and Pharmacology (2003, AOM Press) and Chinese Herbal Formulas and Applications (2008, AOM Press) for which he was lead author.

This article was taken out of Dr. Chen’s book Chinese Herbal Formulas and Applications.
To order a copy, click here.

To learn more about herbs, John Chen is speaking on the following topic for Lotus Institute. The class is approved for 8 CEUs/PDAs by the California Acupuncture Board and NCCAOM.

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